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The Patients' Stories

Mr and Mrs G, an African American Couple

Mr G is a 66-year-old, African American man diagnosed as having stage IV squamous cell cancer of the lung. He has chronic obstructive pulmonary disease and has a 40–pack-year smoking history. A retired factory worker, he lives at home with his wife in a large city in Alabama. After diagnosis, he received radiation therapy and a trial of chemotherapy with vinorelbine and cisplatin. A year after the diagnosis Mr G's disease had progressed and his pain and dyspnea increased, adding to the symptom burden of asthenia, anorexia, and delirium. He was admitted to an inpatient palliative care unit with symptomatic hypercalcemia, treated with fluids and pamidronate, and approximately 1 week later discharged home with hospice services.

Ms Z, a Chinese American Woman

Ms Z is a 38-year-old, Chinese American woman who, along with her older sister, was the primary caretaker for both parents during extended illnesses. She, her older sister, and both parents were born and raised in Hawaii. Her college-educated mother was diagnosed as having stage IIIB adenocarcinoma of the lung. In the 6 months after her diagnosis she underwent 6 rounds of chemotherapy, followed by radiation. Despite treatment, the disease metastasized to the liver, brain, and bones. During a final 10-day hospital stay she continued to undergo radiation treatment. Still hospitalized while hospice was being considered, she died 14 months after the diagnosis at the age of 73 years. Ms Z's father was a prominent business executive and community leader. He was diagnosed as having Parkinson disease in his early 70s and was treated with a combination of levodopa and carbidopa and other medications. He died of complications from Parkinson disease at the age of 78 years, after a brief admission for aspiration pneumonia. Throughout her parents' illnesses Ms Z lived in California and commuted to Hawaii every few months, where her parents, her 40-year-old sister, and several relatives lived.

Perspectives

The interview between Mr G and his European American physician, Dr C, took place during his hospitalization for hypercalcemia. Mr G suggested how physicians could improve their relationship with patients, especially when their cultural backgrounds are different.

MR G:Well, you know, you got to find out the identity of a person to even get to know them. So I think that's a big "if" right there. Because if you don't know a person, you got to find out his identity, go where he lives, where he goes, where he was born, who's in his family. And he's got to open up and tell you these things. Because the more you know about this person, his family, then that'll make you know more about you.